FORM 1023-EZ for JUNGLE CLINICS FOUNDATION INC

Field Data
EIN 47-1492070
Case Number EO-2014223-000323
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JUNGLE CLINICS FOUNDATION INC
Organization’s Mailing Address 636 WALKER RD
City DICKSON
State TN
ZIP 37055-5716
Accounting period End 12
Primary contact name LEALY PROCTOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LEALY PROCTOR
INCORPORATOR AND DIRECTOR
636 WALKER RD
DICKSON TN 37055-5716

Officer/Director/Trustee Two

LONNIE PROCTOR
PRESIDENT
636 WALKER RD
DICKSON TN 37055-5716

Officer/Director/Trustee Three

ANTHONY STEWART
VICE PRESIDENT
600 NELS ADAMS RD
DICKSON TN 37055-5336

Officer/Director/Trustee Four

DYLAN THOMPSON
TREASURER
207 HENSLEE DR
DICKSON TN 37055-2019

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/3/2014
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds No
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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